Nursing Elites

1. A patient’s most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patient’s cancer cells spread?

• A. Hematologic spread
• B. Lymphatic circulation
• C. Invasion
• D. Angiogenesis

Correct answer: B

Rationale: In the case of lung cancer that has metastasized to the bones and liver, lymphatic circulation is a key mechanism by which cancer cells spread from the primary tumor site to distant organs. Cancer cells can invade nearby lymphatic vessels and travel through the lymphatic system, eventually reaching lymph nodes and spreading to other tissues and organs. This route is significant in the metastasis of many types of cancer, including lung cancer.

2. A patient with advanced leukemia is responding poorly to treatment. The nurse finds the patient tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurses most appropriate action?

• A. Tell him that you will give him privacy and leave the room.
• B. Offer to call pastoral care.
• C. Ask if he would like you to sit with him while he collects his thoughts.
• D. Tell him that you can understand how hes feeling.

Correct answer: C

Rationale: Providing emotional support and discussing the uncertain future are crucial.

3. When reviewing the safe administration of antineoplastic agents, what action should the nurse emphasize?

• A. Adjust the dose based on the patient's present symptoms.
• B. Wash hands with an alcohol-based cleanser before and after administration.
• C. Use gloves and a lab coat when preparing and administering the medication.
• D. Dispose of the antineoplastic wastes in the hazardous waste receptacle.

Correct answer: D

Rationale: The correct answer is to dispose of the antineoplastic wastes in the hazardous waste receptacle. Antineoplastic agents are hazardous materials, and proper disposal is crucial to prevent harm to individuals and the environment. Option A is incorrect because adjusting the dose based on the patient's present symptoms may not be safe without proper authorization. Option B is incorrect as hand hygiene should be performed both before and after administering medications. Option C is incorrect as gloves and a lab coat should be worn primarily during handling and administration, not just during preparation.

4. A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo?

• A. Lymphadenectomy
• B. Needle biopsy
• C. Open biopsy
• D. Sentinel node biopsy

Correct answer: D

Rationale: Sentinel lymph node biopsy is a minimally invasive alternative to more extensive lymph node dissection. This procedure involves identifying and removing the first lymph node(s) to which a tumor drains, known as the sentinel node(s), to determine if cancer has spread beyond the primary site. Choices A, B, and C are incorrect because lymphadenectomy refers to the surgical removal of lymph nodes, needle biopsy involves sampling tissue with a needle for analysis, and open biopsy refers to the surgical removal of a sample of tissue for examination, none of which specifically serve as an alternative to lymph node dissection in this context.

5. A client is having a catheter placed to deliver chemotherapy beads into a liver tumor via the femoral artery. What action by the nurse is most important?

• A. Assessing the client’s abdomen beforehand.
• B. Ensuring that informed consent is on the chart.
• C. Marking the client’s bilateral pedal pulses.
• D. Reviewing client teaching done previously.

Correct answer: B

Rationale: Before any invasive procedure, such as placing a catheter to deliver chemotherapy beads into a liver tumor, it is essential to ensure that informed consent has been obtained from the client. This is a legal and ethical requirement that ensures the client understands the procedure, its risks, benefits, and alternatives. Ensuring that the signed consent is on the chart is the most important action the nurse can take before the procedure, as the procedure cannot legally proceed without it.

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